Total hip arthroplasty after previous arthrodesis has been associated with increased complications and decreased survivorship of the prosthesis. We evaluated pain, function, and the factors influencing survivorship of total hip arthroplasties after previous arthrodesis between 1985 and 2000 and compared these results with those obtained in prior years with the same procedure and in the same institution. We retrospectively reviewed 30 patients who had previous spontaneous or surgical arthrodesis. The minimum followup was 2 years (mean, 10.4 years; range 2-20.5 years). Seven failures were identified (23%). The overall survival free of failure was 86% at 5 years and 75% at 10 years. At last followup, 27 of the 30 patients (91%) had no or slight pain, 26 (87%) had a limp, and 18 (61%) needed a gait aid. Surgical arthrodesis, age younger than 50 years at the time of arthroplasty, and length of arthrodesis less than 30 years independently predicted failure. Conversion of arthrodesis to hip arthroplasty reliably decreases pain and improves function, but many patients will limp and require a gait aid. Our outcomes were similar to those after revision rather than after primary hip arthroplasty.

Tibialis anterior tendon transfer (TATT) is performed for treatment of recurrent clubfeet. We investigated the predictability of residual adductus on the future need for TATT. A retrospective review of 143 patients with clubfoot was performed. The patients were divided into two groups: group 1 with a history of TATT and group 2 with no TATT. Heel-forefoot angle (HFA) was measured. HFA was compared between the groups. HFA was significantly different between groups 1 and 2. Residual adductus deformity in clubfeet treated by Ponseti casting is a risk factor for future need for surgical treatment.

The aim of this study was to define the outcome and complications following open reduction and internal fixed-angle plating of distal radius fractures for patients on chronic immunosuppression medications. A retrospective study identified 11 patients with distal radius fractures that had been on chronic immunosuppressive medication. The mean patient age was 59.9 years (40-82 years). According to the Orthopedic Trauma Association classification, there was one 23A3, one 23B3, and nine 23C type fractures.There were two open fractures. All patients received preoperative antibiotics and underwent reduction and fixation with a volar, fixed-angle plate. Postoperative measurements included postoperative and final radiographic indices, wrist flexion and extension, forearm rotation, and grip strength. Clinical follow-up averaged 13 months, and radiographic follow-up averaged 14.9 months. Statistical analysis was performed comparing means of various parameters with a two-sided t test with an alpha value ≤0.05. All fractures healed, and there were no infections. The final mean ulnar variance, volar tilt, and radial inclination were −0.1 mm (ulnar negative; −2.0 to +2.5 mm), 13°(5-23°), and 21°(15-27°), respectively. The mean articular gap or step was 0.4 mm. There was a small but significant decrease between the final and postoperative mean ulnar variance (p=0.03). Mean wrist flexion was 47°, extension 47°, pronation 77°, and supination was 76°. Grip strength averaged 16.3 kg versus 25.1 kg for the opposite extremity. The one major complication included a postoperative carpal tunnel syndrome. Fixed-angle volar plate fixation for distal radius fractures in patients with chronic immunosuppression was associated with union (with acceptable radiographic alignment), no wound-healing problems or infections, and with functional wrist and forearm motion and grip strength.

Can Labor Standards Improve Under Globalization? begins by posing several critical questions. Should labor standards be part of global trade agreements and, if so, can they improve the lives of workers? Who should administer

No abstract